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  • Clinical Research Article
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Serum uric acid/creatinine ratio and metabolic-associated fatty liver disease risks in children

Pediatric Research (2025)Cite this article

Abstract

Objectives

To investigate the correlation between serum uric acid/creatinine ratio (SUA/Cr) and Metabolic-associated fatty liver disease (MAFLD) in children.

Methods

1387 participants aged 4–15 who underwent health examinations from 1/2020–12/2023 were included. Clinical indicators were compared and analyzed.

Results

Overweight/obese group had elevated levels compared to non-overweight/obese group in male proportion, uric acid (UA), serum uric acid/creatinine ratio (SUA/Cr), systolic blood pressure (SBP), diastolic blood pressure (DBP), alanine aminotransferase (ALT), gamma-glutamyltransferase(GGT), total protein(TP), albumin(ALB), globulin(GLO), and serum creatinine(SCr) (p < 0.001, Kruskal–Wallis test). As SUA/Cr increased, UA, ALT, ALP, TP, GGT levels and the prevalence rates of overweight/obesity rose, while SCr levels fell (p < 0.05, Jonckheere-Terpstra test), and positively related to body mass index (BMI) (p < 0.05). The OR for overweight/obesity increased in higher SUA/Cr quartile groups, as Q3 (OR = 2.399, 95% confidence interval CI = 1.554–3.703) and Q4 (OR = 5.044, 95% CI = 3.281–7.754). The SUA/Cr exhibited an AUC of 0.828 (95% CI = 0.764–0.892, p < 0.001) in predicting overweight/obesity and elevated ALT levels, with a specificity of 0.764 and sensitivity of 0. 805.

Conclusions

Children with overweight/obesity have higher liver enzymes, and elevated SUA/Cr levels may predict an increased incidence of overweight/obesity and hepatic injury.

Impact

  • This study found a close association between serum uric acid/creatinine ratio (SUA/Cr) and risk factors for Metabolic-associated fatty liver disease (MAFLD) in children.

  • SUA/Cr may be an indicator of risk factors for MAFLD in children.

  • Elevated SUA/Cr levels may predict an increased incidence of overweight/obesity and hepatic injury.

  • Providing an easily accessible non-invasive biomarker for predicting and preventing MAFLD in children.

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Fig. 1: ROC analysis of SUA/Cr for predicting overweight/obesity and abnormal ALT.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Miaosang Xu and Chunsheng Wu for proving software support and development.

Author information

Authors and Affiliations

  1. Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China

    Bi Chen, Xiaoning Qu, Ting Li & Minghua Jiang

Authors
  1. Bi Chen
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  2. Xiaoning Qu
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  3. Ting Li
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  4. Minghua Jiang
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Contributions

Bi Chen collected data, drafted the initial manuscript, and critically reviewed and revised the manuscript for important intellectual content. Xiaoning Qu conceptualized the study, collected data, carried out the initial analyses, and critically reviewed and revised the manuscript for important intellectual content. Ting Li carried out the initial statistical analyses and critically reviewed and revised the manuscript. Minghua Jiang conceptualized and designed the study, reviewed, and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Minghua Jiang.

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Chen, B., Qu, X., Li, T. et al. Serum uric acid/creatinine ratio and metabolic-associated fatty liver disease risks in children. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04219-2

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